By Karim Seek(Public Health Medical Doctor, Deputy
Co-ordinator of the National HIV/AIDS Programme in Senegal)

As the HIV/AIDS epidemic evolves in the world, the protection of
women is increasingly becoming a major concern. Indeed, from a men-women ratio
of 7/1 in 1990, the rate of infection has inverted to 1.5/1 in certain
countries. Four out of six new cases of infections occur among women aged
between 16 and 24 years.

The vulnerability of women to HIV has been widely documented.
The gravity has been more widespread in sub-Saharan Africa. The low level of
literacy among the majority of women constitutes a major obstacle to efforts to
educate them on the mode of transmission of the disease. The peculiar nature of
AIDS, a deadly disease associated with sexual behaviour, imposes specific
educational strategies which make it possible not only to create awareness on
the risk but also to bring about a change in behaviour with the aim of
protecting women through better control of their sex lives.

The HIV/AIDS prevention education is the responsibility of the
national AIDS programmes. They are assisted in this task by associations and
Non-Governmental Organisations that most often constitute the operational link
in direct contact with the "beneficiaries". Their educational role and
assistance often go beyond the domain of the HIV/AIDS, to include health care,
and other sectors of development.

This paper is a summary of experiences on HIV/AIDS prevention
education of the organisations invited to this workshop. It provides a basis for
discussion on a variety of strategies that have been used so far to tackle the
various aspects of women's vulnerability to HIV/AIDS, strategies which seek to
integrate the social and cultural realities of the target group in question.

ORGANISATIONS

Areas of Intervention

Two main groups of organisations are directly concerned: those
whose activities are exclusively concerned with HIV/AIDS and those whose field
of intervention is wider. The main activities of the first group of
organisations centre around sensitisation, training, back-up support for AIDS
patients or those affected and advocacy.

The second group of the organisations invests in other health
care programmes (family planning, reproductive health, maternal or child
health), as well as in such other sectors as the environment, economy, the
spiritual and more generally, in the promotion of the women's status. The field
of interventions can be summarised as follows:

·
Facilitation and support for women in their religious and social
endeavours.

Target Groups

Women, girls, the youth, whether in school or out-of school,
constitute a common target of the two types of organisations. Organisations
exclusively involved in HIV/AIDS have proposed a greater variety of targets
based on their support activities for people living with HIV, as well as
in the mobilisation of community leaders and other people in some social and
professional categories.

With regard to illiterate and neo-literate women, the
quasi-totality of the organisations already include them among their targets, in
which they represent a proportion varying between 50% to 90%. The age brackets
are very wide, most often ranging between the age of 15 and 70 years. However,
particular attention is devoted to young people aged 15 to 25 years.

Target Groups of Specific Organisations:

· Women and girls in
pen-urban and rural areas, either within organised groups or in high risk
situations;· Pupils and female
Students;· Young adolescent girls.· Persons living with HIV/AIDS· Prostitutes and their clients;· Leaders and Policy makers;· Men and women of the community;· Organisations and individuals involved in
projects;· Police, social and judicial
workers, traditional and political authorities.

It is generally composed of three to four levels: level of
orientation/decision, level of execution and operational level.

For about 45% of the organisations, the level of
orientation/decision is handled by a deliberating assembly (general assembly,
Synod, Convention...) with decentralised membership based on areas of
intervention (regional or provincial commissions). In the other organisations,
the orientation/decision post is occupied by a chairwoman or a female
co-ordinator.

The level of execution generally involves several units of
intervention, led by the chief of programs. The number of units as well as their
tasks vary according to the domains of intervention.

The operational level has to do with field operators. It is made
up of either grassroot community groups (village groups, associations) or
community relay teams, peer educators, or even active members of organisations
(voluntary women, project assistants, field teams). Whatever the composition,
this operational level has, in all organisations, benefited from basic training
related to field activities. This training has more often been organised in
batches (training of trainers, field training) generally by IEC experts of the
National AIDS campaign Programs, as well as by those from some national or
international NGOs (INTRAH, AMPPF, AIDSCAP).

In the field, 60% of the work of the supervisor in most cases
consists of co-ordinating activities and implementing programs according to the
established plan. In some cases, however, they directly play the roles of
animators and facilitators on the occasion of awareness-raising meetings.

ACTIVITIES ON EDUCATION FOR HIV/AIDS PREVENTION

Areas of Activities

The activities of the HIV/AIDS prevention education are made up
of training, sensitisation, support and care, advocacy and various other types
of activities associated with the development of aids, research and networking.

· Taking charge of
infected people;· Advocacy for infected
women and the affected;· Home care during
terminal phase· Assistance to people living
with HIV through micro-projects;· Income
generating activities.

The most commonly support materials used are the graphic ones
(folders, picture books, and posters) and audiovisual materials (video films).
The demonstration on the utilisation of the condom with the help of model penis
seems very common. On the other hand, fewer space is devoted to the theatre and
plays. Most of these aids are either produced by the organisations themselves or
by the national partners (Ministry of Health, national HIV/AIDS Programs) with
the financial support from international partners.

Traditional support systems

The quasi-totality of organisations think that some of the
messages designed for HIV/AIDS prevention can be transmitted through objects in
use in daily life (cloth/pottery, etc.) and by so doing induce discussion, ease
taboos and help as constant reminder. Several suggestions have been made to this
effect:

· Weaving of
loincloth with drawings showing the modes of transmission or signifying death
and captions in the national language;

· Training in tie-dying, batik
and sengraphy using educational images on AIDS;

· Pottery, arts, plates, hand
bags and market bags

Channels of communication

In close to two-thirds of the cases, research has been conducted
to identify the most appropriate channels of information for the various target
groups. The main methods used were:

· The organisation
of proximity awareness meetings, talks (focus group) with the various men and
women age groups in the villages,

· Baseline surveys and
evaluation of target groups' needs;

· Personal contacts, family
visits,

· Seminars and group
discussions,

· Peer education.

Peer education is often highlighted as one of the best channels
of communication (women-to-women, youth-to-youth, men-to-men) Further-more,
dramatic activities seem to be more appropriate for illiterate people,
out-of-school young people and those in rural areas, while video and play
activities are appreciated by young people in school. The media as well as the
traditional communicators (griots) are sometimes cited.

Designing and developing programmes

Close to 90% of the organisations have carried out preliminary
studies before the preparation of the educational programmes. The methods often
used are:

Those who did not first carry out an initial assessment,
prepared their program based on a community initiative which spontaneously
highlighted the needs. Some organisations, however, conducted initial studies
but in domains other than HIV/AIDS.

On the other hand, only 35% of the organisations conducted final
or midterm assessment of their programs. In most cases, it was participatory
self-assessment with leaders of focus groups to assess the impact of the
messages. Some external evaluations were, however, undertaken by the research
institutes, international NGOs and universities, the UNAIDS and co-operation
agencies.

Evaluation

These assessments resulted in the adaptation of strategies and
orientations, messages or the educational materials. The results of the surveys
have also been used for the:

· rectification of
sketches, based on the suggestions of resource persons in theatre and the target
group.

· inclusion of women teachers in
target groups of the project destined only for mothers and their girls.

· production of materials in
vernacular language with reinforced graphics

· modification of the time
chosen for intervention as well as the subjects discussed at meetings.

· developing more specific
themes such as negotiations on the use of the condom, relationship between
STD/HIV.

MESSAGES

General Features

There is a large predominance of the tripod of "abstinence -
fidelity -condoms". These topics are however, arranged according to targets.
Abstinence and fidelity are especially destined for young school children, with
an orientation toward condom use for non-school going youths. Fidelity and use
of male and female condoms are advocated for couples. For young girls, emphasis
is placed on protective behaviour vis-a-vis premature sexuality. The wider pubic
is especially provided with information of a general nature on AIDS, the modes
of prevention, risky behaviour, family and sexual health and promotion of AIDS
tests.

Teenagers

· Abstinence and
fidelity for teenagers and young persons especially in school
environments;· Condoms for out-of-school
youth;· Stopping sexual exploitation of
children.

Couples

· Reciprocal
fidelity;· Use of male and female condoms
for married couples.

Young Girls

· Choice of a
faithful partner;· "I love my
body";· "Young girls you have the right to
say no"

· Adoption of
risk-free attitude to sex;· Definition of
AIDS and modes of prevention,· Family and
sexual health;· Sexually Transmitted
Diseases;· Promotion of AIDS testing and
diagnosis.

More Specific Features

The gender approach

Close to the two-thirds of the organisations assert that they
take Gender into account in the preparation and dissemination of educational
messages. The biological and socio-economic vulnerability of women in addition
to the fact that sexual intercourse is forced on women often justify this
approach. But concern on the need to raise the level of risk awareness should
also be taken into account so as to encourage men to show greater respect and
protection toward women.

The approach goes beyond mere dissemination of the message. Some
organisations are involved in overall promotion of women in order to achieve
greater balance of power between men and women. Concretely, it can boil down to
efficient management of homes by both men and women such that each and everyone
has the opportunity to attain their full social, moral and economic potential.
The most relevant strategy to achieve this objective consists in organising
awareness workshops on Gender, to encourage women and men to first think
separately then to discuss together.

The gender approach is not, however, universally applied. Some
organisations believe that only women should be involved considering the fact
that they are composed of women specifically. For others, men and women run the
same risk of contamination. Promotion of methods of prevention familiar to women
such as the use of female condoms is another reason adduced to reduce the
emphasis placed on male condoms for too long.

Dialogue

The majority of organisations encourage couples, parents and/or
children to discuss these issues related to sexual health. Two types of methods
are used:

· peer education
that encourages dialogue within the same age-group (IEC program
"children-to-children" in schools, sensitisation "Parents-to-parents");

· the introduction of programs
based on communication workshops which encourage dialogue between various
age-groups (mother-to-daughter, parents-to-children).

Promotion of risk-free sex

Sexuality among the youth is a subject which has been widely
integrated by the organisations. Starting from the notion that the youth are
sexually active but immature, they have some specific needs in terms of
prevention. The role of elders as models of good behaviour is also recommended.
Some indications testify to this preoccupation, for example, the presence of
young animators in the organisations, and the holding of public meetings without
distinction of sex among youth organisations.

Issues associated with casual sexual relations outside marriage
are also incorporated by organisations. Several types of strategies have been
put in place, among others:

· Emphasis on
spiritual precepts: "God and the Church condemn sexual relations before marriage
known as fornication while the extra-marital sex is termed adultery";

· Sensitisation on the risk of
social stigmatisation faced by women, a risk that does not weigh as much on
men.

80% of the organisations hold the view that their program
strengthens the capacity of women and men to negotiate in risk-free sexual
relations. This opinion is based on the specific experiences of training in
sexual relations negotiations especially with prostitutes. Furthermore, among
couples, women are encouraged to discuss and use contraceptives. In a similar
vein, women gain more confidence through specific training programs on
self-affirmation and the capacity to communicate, and by strengthening their
economic independence. Besides, some indicators give an idea on this change
through the ability to convince husbands to use the condom, confidence and
freedom to speak in public on these issues.

Rape and sexual harassment appear to get less attention from the
organisations. Less than two-thirds of them tackle these problems, either by
setting up specific programs (Program against violence on women, periodic
seminars on the prevention of rape in homes and places of work), either through
mobilisation and advocacy (support to young women victims of sexual harassment,
wide-scale mobilisation against proven cases of rape and testimonies of
victims). Sensitisation on the risks of AIDS associated with rape and on the
rights of women, is among the applied strategies.

CONDOMS

Accessibility to male condoms is encouraged by almost all the
programs without distinction of sex. Distribution at the community level, free
distribution especially among target groups (prostitutes, young people), or the
orientation of people toward sales outlets or distribution points promote easy
access. On the other hand, femidon remains an object of curiosity or for
experimentation in many countries, whereas it is available at affordable prices
in certain regions of the continent.

The majority of organisations (83%) feel they provide answers to
the problems associated with the use of condoms by both men and women. There is
a wide variation in the methods employed: campaign against false notions on the
use of condoms, sustained promotion of the condom, group discussions and
workshops as well as forums attended by the two sexes are among the advocated
methods.

Training on the use of the condom almost always concerns men and
women. The latter often play the role of contact-person within homes and in
their community and most educational sessions end with a demonstration on how to
use condoms. The use of drawings and posters seems to be a good way of conveying
messages on this topic. Some organisations, however, have complained about the
difficulties they encounter when meetings are organised simultaneously for the
two sexes.

SUPPORT FOR PERSONS LIVING WITH HIV/AIDS

Organisations working exclusively on HIV/AIDS say they provide
support for persons who are HIV positive so that they can live positively with
HIV/AIDS. They achieve this mainly through sensitisation on the need for
solidarity and non-rejection of sick persons as well as by undertaking some
psycho-social work (listening to persons, support, food and medical support,
income generating activities).

The few organisations of this type that do not initiate support
activities have said that they require improved training to meet the needs and
that they collaborate with those more experience in the meantime. The
formulation of messages seems in most cases to take into account the needs of
infected people. Avoiding such words as "victim", dissociating HIV/AIDS from the
mode of living, sessions on the needs of infected persons are some of the ways
of reducing discrimination and creating an environment of solidarity and
compassion around such persons.

PROSPECTS AND EXPECTATIONS

The organisations have expressed their needs regarding the
improvement of their programmes and as regards the workshop.

Immediate Requirements for Improving Prevention Education
Programmes

These can be classified as follows:

· Need of adapted
materials/aids which can be used easily by the illiterate women while conveying
the appropriate messages;

· Needed expertise for more
judicious evaluation of needs, more adequate planning, better approach to new
techniques and to the concept of gender;

· Material needs: audiovisual,
teaching aids, logistics;

· Financial
Needs.

Expectations from the workshop

Strategic and operational requirements/or:

· strengthening of
prevention education activities among female groups;· change of behaviour particularly at grassroots
level;· identifying key issues to be
considered mainly for the youth;· efficient
communication strategies for women and the young.

The need for research on:

· the role of
culture/tradition on HIV/AIDS prevention education;· influences of social norms and especially the gender
imbalance on the implementation of prevention programs;· effectiveness of peer education within the
programs;· role of community educators in
the anti-HIV/AIDS campaign.

Strategic needs associated with the status of women in
order to:

· reinforce
the power of women and the youth;· protect
women against risky-behaviour (prostitution);· reinforce the rights of women (access to resources
and inheritance),· understand the relations
between tradition, status of women and HIV/AIDS prevention,· ensure the sustainability of activities led by
women,· promote education to
self-help,· promote the use of female
condoms

Support to infected persons

· Setting up of
monitoring and counselling centres,· More
positive support for the sick by the society

CONCLUSION

Female vulnerability to HIV/AIDS is no longer in doubt According
to WHO, it even seems as if female seropositivity is likely to become one of the
major challenges of public health in the coming years Numerous activities have
been initiated for the benefit of women, to protect them against infection
sensitisation, training, skills acquisition or more globally, promotion of the
status of women, are among the responses provided to various degrees by the
women's grassroot organisations At this stage of the evolution of the epidemic
and knowledge about it, the objective has, in fact, gone beyond the mere
dissemination of information to create a real perception of risk likely to lead
to the change of behaviour To this effect, the recommendations of the UNAIDS
are, among others, to support the development of prevention programs that
provide the messages and the appropriate skills as well as support services
destined for both men and women including the marginalised or those who are
difficult to reach These programmes should lay emphasis on the importance of
condom use and on the mutual responsibility of men and women to adopt safe sex
practices It has also been recommended that these programmes be integrated in
other community development activities such as literacy and income-generating
activities.